A review of 111 anaesthetic patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Efficacy of fibrinogen concentrate in major abdominal surgery – A prospective, randomized, controlled study in cytoreductive surgery for pseudomyxoma peritonei

“…Because of its complexity, the surgery is often prolonged; a previous study reported that 84% of such operations required 7 to 12 hours to perform, whereas 9% lasted for more than 12 hours . CRS with HIPEC for extensive peritoneal malignancy, such as advanced PMP, may be associated with large‐volume blood loss and substantial use of blood products such as plasma (e.g., 5‐6 units) and red blood cells (RBC; e.g., 4 units) . Mean blood loss has been estimated to be approximately 1500 mL (ranging up to approximately 5000 mL), with as many as three‐quarters of patients requiring transfusions of allogeneic blood products .…”

“…CRS with HIPEC for extensive peritoneal malignancy, such as advanced PMP, may be associated with large‐volume blood loss and substantial use of blood products such as plasma (e.g., 5‐6 units) and red blood cells (RBC; e.g., 4 units) . Mean blood loss has been estimated to be approximately 1500 mL (ranging up to approximately 5000 mL), with as many as three‐quarters of patients requiring transfusions of allogeneic blood products . Effective coagulation management is therefore essential to help achieve successful outcomes.…”

Investigating the association between perioperative blood transfusions and outcomes in children undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

“…Our study also failed to demonstrate any advantage of postoperative blood transfusions over intraoperative blood transfusions, as both were associated with poor survival. With blood transfusion rates of 30–77% during CRS–HIPEC , larger studies examining the difference in outcomes as it relates to the timing of transfusions may allow the more judicious use of blood.…”

Anesthetic implications in hyperthermic intraperitoneal chemotherapy

“…Various studies have reported deranged prothrombin time (PT) with international ratio (INR), decreased AT III and fibrinogen values, a prolonged actived partial thromboplastine time (aPTT) and a thrombocytopenia. [ 24 ] Additionally, patients may have platelet dysfunction due to extreme variation in the temperature. Advanced point of care coagulation monitoring such as thromboelastography (TEG) may help to detect complex coagulation disorders such as hyperfibrinolysis, thrombocytopathia, or factor XIII deficiency[ 25 ] These patients have a large laparotomy incision and should be provided with good perioperative analgesia.…”

“…Advanced point of care coagulation monitoring such as thromboelastography (TEG) may help to detect complex coagulation disorders such as hyperfibrinolysis, thrombocytopathia, or factor XIII deficiency[ 25 ] These patients have a large laparotomy incision and should be provided with good perioperative analgesia. [ 24 ] Primary opioid based analgesia (Morphine) should be used with caution as it may be associated with increased respiratory complications and need for ventilator support. Epidural provides good analgesia but is associated with an increased risk of hemodynamic disturbance due to extensive surgery and these patients are prone to develop spinal hematoma due to coagulation abnormalities and thrombocytopenia.…”